Microbiology and management of post-surgical wounds infection in children

Abstract

The recent increased recovery of anaerobic bacteria from children has led to greater appreciation of their role in paediatric infections at all body sites, including post-surgical wounds (PSW). In studies that employed adequate method for recovery of aerobic and anaerobic bacteria polymicrobial, aerobic and anaerobes were isolated from over half of the patients with PSW. The wounds studied were those that developed following these surgical procedures: head and neck surgery for malignancies, post-thoracotomy, spinal fusion and gastrostomy tube insertion. Staphylococcus aureus and aerobic gram-negative bacilli were found at all sites. However, a correlation was generally found between the site of the wounds and microbial flora recovered from the wound. Organisms that resided in the mucous membranes close to the surgical site predominated in the wound next to these areas. Enteric Gram-negative rods, Group D enterococcus and Bacteroides fragilis group predominated in wounds relating to the gut flora, while Streptococcus spp., pigmented Prevotella and Porphyromonas spp. and Fusobacterium spp. were most frequently recovered in wounds proximal to the oral area. Management of PSW should include administration of antimicrobials effective against the polymicrobial bacterial flora adjacent to the anatomic site of the wound.